言語による代償と起立訓練の導入によりADL介助量が軽減した左半側空間無視を呈する重度片麻痺患者

Effectiveness of compensation utilizing verbal functions and stand-up exercises leading to a reduced need for assistance with ADL for a case of severe unilateral spatial neglect

要旨：脳室穿破を伴う右視床出血で，左半側空間無視や全般性・分配性注意障害を呈した症例に対して，言語機能が残存していることに着目し，車椅子移乗時にその工程を本人が言語化すること（自己教示）を促し，さらには作業療法・理学療法時と病棟内で起立訓練を指導する包括的アプローチを実施した．移乗動作の工程を繰り返し言語化することで失敗点の学習が進み，工程を習得することができた．また，多感覚入力による左半側空間無視の改善と，下肢・体幹筋力増強を目的に起立訓練を行い，ADL介助量が減少した．以上より，残存している機能に着目し，身体機能と認知機能の両側面に対して包括的にアプローチする車椅子移乗，および起立訓練の有用性が示唆された．

　This study examined the effectiveness of a comprehensive rehabilitation approach, comprising compensation based on verbalization and stand-up exercise, and focusing on preserved functions. The patient suffered from left unilateral spatial neglect and general and selective attentional dysfunction due to right thalamic hemorrhage and subsequent intraventricular rupture. During transfer training in moving from one supporting surface to another, the patient became aware of when she failed and how as she was encouraged to verbalize each step of transfer repeatedly, leading to an improvement in transfer ability. Stand-up exercise was employed to give her multiple sensory inputs aimed at improving unilateral spatial neglect and to strengthen muscles of the lower extremity and trunk, which led to a reduced need for assistance with ADL. The study showed the usefulness of the rehabilitation approach focusing on residual functions and the effectiveness of the use of stand-up exercise which works on physical and cognitive functions in a comprehensive manner.